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What Is Injection-Compressive Sclerotherapy?
It is nothing more than a specialized form of wound healing. All
wounds result from inflammation and then heal with scar tissue.
Have you ever experienced a laceration to your skin? It may not
have been too severe to go to the emergency room for suturing. You
can tape the gaping wound together. And after a few days, you remove
the tape and you notice that the wound is no longer gaping, but
is sealed. Distraction of the wound if applied vigorously would
open the wound. After a few weeks the wound is healed, and the same
distraction force would no longer open the wound. This phenomenon
is exactly what occurs with sclerotherapy. Inflammation is caused
within a short segment of your diseased vein by injecting a material
that is safe and painless. The inflammation results in the body
producing a protein called fibrin. This is the glue that closes
the vein when both walls of the vein are compressed together. When
the vein is glue-closed; blood does not flow within it, and the
vein disappears. This is the desired result, and it improves the
circulation of your legs. Next compression of the vein is maintained
while you are upright on your feet using a special compression stocking.
This, with walking at least one hour total per day, will keep the
veins relatively free of blood so scar tissue will form within the
vein and seal it off permanently. The vein will turn to a hard cord
beneath the surface of you skin and eventually will disappear completely.
This procedure takes from 30-45 minutes in the doctor's office.
A treatment session covers all abnormal veins on the leg treated.
Sometimes the veins are very big or very numerous and it may take
more than one visit to close them. The procedure is painless other
than feeling the tiny needle as a mosquito bite. You can resume
your normal activities right after treatment.
What Types Of Sclerosing Solutions Are Used?
In our office we use two types of solutions to close abnormal veins.
Sotradechol and polidocanol are the agents we use exclusively. We
have found that over 99.9% of veins can be closed using these agents
safely. We do not use saline or salt solutions. Saline, although
effective to some degree, is very painful when injected and it cause
painful muscle spasms and abundant bruising. If it leaks out of
the vein in any significant quantity, it will cause the overlying
skin to break down. This will eventually heal with a scar. It's
only good attribute, is that it does not produce allergy when made
fresh without preservatives. However, most commercially available
saline is packaged with preservatives which in themselves may cause
allergy. Sotradechol is used in our office mainly for large varicose
veins. This substance is much better tolerated. Some patients may
experience a transient burning sensation. The incidence of allergy
is low. Polidocanol is used extensively in our office mainly for
small or spider vein disease. This agent is much safer than the
other two. Allergies and skin breakdown are very rare in the concentrations
used. Because polidocanol has anesthetic properties, no pain is
experienced during treatment. These properties make polidocanol
the almost ideal sclerosant.
How Do I Prepare For Treatment?
There is no need to do anything special. But if you are on a strict
diet, we recommend that you moderate it during the course of treatment.
Your body needs nourishment in order to heal itself. And because
of that, you should eat and drink something before your treatment
session. If it is found that a surgical ligation is required, then
fasting for 6 hours prior to the procedure is required. A snack
will be provided after the procedure. You should not shave your
legs or use any kind of lotion on your legs the day of your treatment.
This may cause a rash to appear. Please bring with you a comfortable
pair of shorts.
Is There Anything I Need To Do After
Treatment Visits?
You will be given an attractive surgical support hose to wear following
your treatment. These stockings will help speed healing and the
disappearance of your unwanted veins. Wear them continuously after
treatment for 48 or 72 hours as instructed. Afterwards, wear them
when you are on your feet. You may take them off at night or when
you are lying down. We recommend you avoid leg massages during your
course of treatment; and the use of aspirin, ibuprofen and like
drugs for 6 weeks following treatment. All herbal medications such
as glucosamine and chondroitin and gingko biloba should be discontinued.
These drugs are anti-inflammatory and when used will undo what was
gained by treatment. After 6 weeks you may use these drugs without
fear of recurrence of your veins. We also encourage you to take
1000 mg Vitamin C during treatment on a daily basis. This tends
to lessen the development of any bruising. Naturally, it is very
important to follow any other specific instruction you are given. Remember that it is essential you
walk at least one hour daily spread out throughout the day, do not
stand motionless, always move your leg muscles. Avoid high impact sports, hot tubs, running during your course of
treatment. If you develop a persistent sneeze or a cough, have it
controlled immediately as they will elevate your venous pressure
and open up glued- shut veins. Afterwards you will be able to do
anything without restriction and with healthy good-looking legs.
Veins that appear dark or may be slightly tender and bumpy. This
is called "trapped blood". Insufficient compression and
or insufficient walking when a vein starts to close causes trapped-blood.
This trapped blood looses its oxygen and becomes an irritant to
the vein wall and pain is felt. Generally, this trapped blood will
disappear in time. If it is tender, we advise aspirating this blood
in the office. This will cure the discomfort and speed recovery.
This procedure is an additional expense.
What About Lasers?
When lasers first appeared, it was hoped that their use would replace
the need to perform sclerotherapy. Over time this did not materialize.
Many different lasers with slight differences could not reproduce
the good results of properly done sclerotherapy. Inexperienced doctors
tried to treat all vein sizes and as a result incurred skin burns
and scars and pigmentary changes which were permanent in the skin.
We physicians now know that laser vein removal can only be used
on veins of less than half a millimeter in diameter safely. The
reason for this is the limited ability of our skin to transfer the
laser energy through it. For this reason, at Vein Clinics we use
this vascular laser selectively to remove fine veins on the face
and legs.
What are the latest treatments that you may see advertised?
“Closure” is a term you may hear about. This procedure
is done by making a incision over a large vein under local or general
anesthesia. A fiber catheter is inserted through which a laser is
connected. The laser burns the vein from the inside causing it to
turn into scar tissue. Besides using a laser another twist to this
procedure is using radio frequency current to do same job. We do
not use these treatments because they cause skin scars, can perforate
the vein causing hematomas, and are painful. Sclerotherapy does
the same job without these potential complications. With sclerotherapy
we can repair the vein rather than destroying it in its entirety.
We prefer to save the greater saphenous vein in the thigh as it
is the best choice as a bypass arterial graft for coronary arteries.
A new twist on stripping veins has emerged that removes the large
vein by inverting it through itself as it is removed. I see no advantage
to this method over the techniques that I use and which are described
in this pamphlet. Another procedure that you may hear about is called
phlebectomy. This procedure tries to occlude the feeder veins that
supply a varicose vein by multiple tiny incisions in the skin of
the leg and dividing the underlying vein. This procedure leaves
visible scars, is painful, causes large bruises and is very costly
compared with the treatments performed in this office.
Do I Need Someone To Drive Me Home After Treatment?
Definitely not. One of the best things about our treatment method
is that you can go right back to work or your everyday routine.
We find that dedication to regular walks speeds disappearance of
your veins, protects against their reappearance, tones your muscles,
maintains your weight, and promotes a state of health. Bed rest
will not help and we discourage it.
How Long Does It Take For The Vein To Disappear?
Again, it depends on your individual case. Some people will experience
results faster than others. Older patients tend to require more
treatment sessions than younger patients. You may require more than
one treatment session for unusually large or distended veins. If
you have extensive varicose veins on the thighs and calves of both
of your legs, treatment will require several sessions. Having treatment
sessions twice a week or having a double treatment session can obtain
accelerated results. On this program, the total time wearing stockings
will be reduced.
What About Spider Veins?
Spider veins are tiny. They are treated using injections with exceedingly
fine needles. It is difficult to predict how many injections are
necessary to eliminate an area of spider veins. Spider veins are
like the leaves of a tree, the trunk being the larger blue veins.
When the trunk of the tree is cut the entire tree dies including
its leaves. With veins, this analogy is partly correct. Some spider
veins may be fed by more than one large vein trunk. Because of this,
additional visits will usually be necessary to treat the remaining
spider veins.
Will My Varicose Veins Ever Come Back?
Varicose disease is a chronic condition. If you have the inherited
tendency, you will always be at risk of developing them. It is possible
that new varicose veins may occur. No treatment can protect you
against this. Sclerotherapy as practiced today, using limited surgical
ligation in selected cases, use of duplex ultrasonography to see
the problem beneath the skin, newer materials and techniques, can
protect you against a form of recurrence that other forms of therapy
cannot. As a result, your chances of getting recurrent varicose
veins are much lower than with older methods. If new veins do appear
in the future, they can usually be cleared up with a "touchup"
treatment sessions.
The most frequent causes for recurrence is failure to follow our
instructions to the letter. Try to avoid getting a cold, or hayfever
with it's coughing and sneezing. This will increase the venous pressure
in your legs, causing the "glued" veins to pop open. It
takes 6-8 weeks following treatment for veins to become permanently
closed. Your cooperation during this time will be greatly rewarded
with anticipated results and low costs.
Will My Insurance Plan Pay For The Treatment?
Your treatment is covered by many insurance plans if not done solely
for cosmetic reasons. We will be happy to contact your insurance
company to determine your coverage and assist you in filing your
claim. You are responsible for payment of services rendered at each
treatment session.
What I must know when comparing treatments and costs of other Physicians?
Different physicians have different criteria of what constitutes
a treatment session. Some physicians charge $150 and less for a
10-15 minute treatment session that treats only a small area of
spider veins on a leg. Patients then are expected to return often
for more of these small treatment sessions. Expect 6-12 months or
longer depending how often you have this mini treatment before all
your abnormal spider veins are removed. The total costs of all these
mini treatments will be high and you will have to wait a long time
to enjoy your legs with cotton balls, tape and ace bandages. Contrast
these treatments with the treatments commonly practiced at the Vein
Clinics of the Valley. A treatment session lasts an hour; treats
all abnormal veins on one leg for a cost of $550. This includes
spider and large varicose veins. Total number of treatments average
2-3 per leg for extensive vein disease. Patients with less severe
disease will require fewer treatments. All abnormal veins are removed
and your leg is returned to normal within one month. During this
time you wear a specially fitted and stylish compression hose. The
total cost is less than other physicians and you can enjoy your
beautiful legs much sooner. If for financial reasons you would like
to have mini treatments, they can be performed in our office. You
may start with these treatments and later accelerate your results
with regular treatment sessions.
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